RIM V3 Ontology including RIM top level classes and data types. Based on HL7 RIM Balot May 2006, also partly based on Bhavna Orgun's RIM ontology http://www.ics.mq.edu.au/~borgun/Software.html
Developed by Helen Chen and Anju Sharma, Agfa HealthcareA substance (player) added to a mixture (scoper) to make it taste a certain way. In food the use is obvious, in pharmaceuticals flavors can hide disgusting taste of the active ingredient (important in pediatric treatments).The act of putting something away for safe keeping. The "something" may be physical object such as a specimen, or information, such as observations regarding a specimen.The territory of a city, town or other municipality.A role played by a place at which health care services may be provided without prior designation or authorization.An entity (player) that acts or is authorized to act on behalf of another entity (scoper).A request for authorization to perform a kind of service.
This is distinct from RQO which is a request for an actual act. PERMRQ is merely a request for permission to perform an act.Discussion:Roles played by entities and scoped by entities that identify them for various purposes.Supply orders and deliveries are simple Acts that focus on the delivered product. The product is associated with the Supply Act via Participation.type_cd="product". With general Supply Acts, the precise identification of the Material (manufacturer, serial numbers, etc.) is important. Most of the detailed information about the Supply should be represented using the Material class. If delivery needs to be scheduled, tracked, and billed separately, one can associate a Transportation Act with the Supply Act. Pharmacy dispense services are represented as Supply Acts, associated with a Substance_administration Act. The Substance_administration class represents the administration of medication, while dispensing is supply.An entity (player) that is maintained by another entity (scoper). This is typical role held by durable equipment. The scoper assumes responsibility for proper operation, quality, and safety.Target on behalf of whom the service happens, but that is not necessarily present in the service. Can occur together with direct target to indicate that a target is both, as in the case where the patient is the indirect beneficiary of a service rendered to a family member, e.g. counseling or given home care instructions. This concept includes a participant, such as a covered party, who derives benefits from a service act covered by a coverage act.This context represents the information acquired and recorded for an observation, a clinical statement such as a portion of the patient's history or an inference or assertion, or an action that might be intended or has actually been performed. This class may represent both the actual data describing the observation, inference, or action, and optionally the details supporting the clinical reasoning process such as a reference to an electronic guideline, decision support system, or other knowledge reference.Represents concepts related to invoice processing in health careA therapeutically active ingredient (player) in a mixture (scoper), where the mixture is typically a manufactured pharmaceutical.The 'typical' state. Excludes "nullified" which represents the termination state of a Role instance that was created in error.An address part is essentially a character string that may have a type-tag signifying it�s role in the address. Typical parts that exist in about every address are street, house number, or post box, ZIP code, city, country but other roles may be defined regionally, nationally, or on an enterprise level (e.g. in military addresses). Addresses are usually broken up into lines, which is indicated by special line-break tokens.
Addresses are conceptualized as text with added mark-up. The mark-up breaks the address into lines and describes the role of each address part if it is known. Address parts occur in the address in the order in which they would be printed on a mailing label. The model is similar to HTML or XML markup of text.The Consent class represents informed consents and all similar medico-legal transactions between the patient (or his legal guardian) and the provider. Examples are informed consent for surgical procedures, informed consent for clinical trials, advanced beneficiary notice, against medical advice decline from service, release of information agreement, etc.
Some consent has a minimum required delay between the consent and the service, so as to allow the patient to rethink his decisions. This minimum delay can be expressed in the act definition by the ActRelationship.pauseQuantity attribute that delays the service until the pause time has elapsed after the consent has been completed.An undesirable act that is likely to occur.The facility where the service is done. May be a static building (or room therein) or a moving location (e.g., ambulance, helicopter, aircraft, train, truck, ship, etc.)A Region of Interest (ROI) specified for an image using an overlay shape. Typically used to make reference to specific regions in images, e.g., to specify the location of a radiologic finding in an image or to specify the site of a physical finding by "circling" a region in a schematic picture of a human body. The units of the coordinate values are in pixels. The origin is in the upper left hand corner, with positive X values going to the right and positive Y values going down. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type "subject" (SUBJ), which must always be present.ISO Object Identifier: A globally unique string representing an ISO Object Identifier (OID) in a form that consists only of numbers and dots (e.g., "2.16.840.1.113883.3.1"). According to ISO, OIDs are paths in a tree structure, with the left-most number representing the root and the right-most number representing a leaf.
Each branch under the root corresponds to an assigning authority. Each of these assigning authorities may, in turn, designate its own set of assigning authorities that work under its auspices, and so on down the line. Eventually, one of these authorities assigns a unique (to it as an assigning authority) number that corresponds to a leaf node on the tree. The leaf may represent an assigning authority (in which case the root OID identifies the authority), or an instance of an object. An assigning authority owns a namespace, consisting of its sub-tree.
OIDs are the preferred scheme for unique identifiers. OIDs should always be used except if one of the inclusion criteria for other schemes apply.A criterion or condition over service events that must apply for an associated service to be considered.A party, who may or should receive or who has recieved the Act or subsequent or derivative information of that Act. Information recipient is inert, i.e., independent of mood." Rationale: this is a generalization of a too diverse family that the definition can't be any more specific, and the concept is abstract so one of the specializations should be used.A categorization of competency of the Entity that plays the Role as defined by the Entity that scopes the Role.
An Entity, in a particular Role, can participate in an Act. Note that a particular entity in a particular role can participate in an act in many ways. Thus, a Person in the role of a practitioner can participate in a patient encounter as a rounding physician or as an attending physician. The Role defines the competency of the Entity irrespective of any Act, as opposed to Participation, which is limited to the scope of an Act.
Each role is 'played' by one Entity (the Entity that is in the role) and is usually 'scoped' by another. Thus the Role of 'patient' is played by (usually) a person and scoped by the provider from whom the patient will receive services. Similarly, the employer scopes an Employee role.
The identifier of the Role identifies the Entity playing the role. This identifier is formally either issued by the scoping Entity or, at least, formally recognized by the scoping Entity as an identifier of the Role.
Attributes of Role are those that are particular to the playing entity while in the particular role.
Rationale: Requires further constraint: invariant (Role x) where x.nonNull x.played_by.nonNull.or(x.scoped_by.nonNull);1111A financial account established to track the net result of financial acts.A role played by an individual who is a student of a school, which is the scoping entity.A role played by a place at which services may be provided.An agent role in which the agent is an Entity acting in the employ of an organization. The focus is on functional role on behalf of the organization, unlike the Employee role where the focus is on the 'Human Resources' relationship between the employee and the organization.In which the relationship is formally defined, frequently by a contract or agreement.Entity that is currently in the possession of a holder (scoper), who holds, or uses it, usually based on some agreement with the owner.A contract whose value is measured in monetary terms.A person assisting in an act through his substantial presence and involvement This includes: assistants, technicians, associates, or whatever the job titles may be.These are moods describing activities as they progress in the business cycle, from defined, through planned and ordered to completed.An entity (player) that has been recognized as having certain training/experience or other characteristics that would make said entity an appropriate performer for a certain activity. The scoper is an organization that educates or qualifies entities.Organizer of entries. Navigational. No semantic content. Knowledge of the section code is not required to interpret contained observations. Represents a heading in a heading structure, or "organizer tree".
The record entries relating to a single clinical session are usually grouped under headings that represent phases of the encounter, or assist with layout and navigation. Clinical headings usually reflect the clinical workflow during a care session, and might also reflect the main author's reasoning processes. Much research has demonstrated that headings are used differently by different professional groups and specialties, and that headings are not used consistently enough to support safe automatic processing of the E H R.A procedure or treatment performed on a specimen to prepare it for analysisA living subject from the order of plants.Concept Role: The concept role is used to send code modifiers with optionally named roles. Both modifier roles and values must be defined by the coding system.
For example, if SNOMED RT defines a concept "leg", a role relation "has-laterality", and another concept "left", the concept role relation allows to add the modifier "has-laterality: left" to a primary code "leg" to construct the meaning "left leg".
The use of modifiers is strictly governed by the code system used. The CD does not permit using code modifiers with code systems that do not provide for modifiers (e.g. pre-coordinated systems, such as LOINC, ICD-10 PCS.) The rules of the modifier use must be governed by the code system (e.g., recent SNOMED RT revision, GALEN.)An association between two Entities where the playing Entity is considered in some way "part" of the scoping Entity, e.g., as a member, component, ingredient, or content. Being "part" in the broadest sense of the word can mean anything from being an integral structural component to a mere incidental temporary association of a playing Entity with a (generally larger) scoping Entity.Sender transmits a status change pertaining to the focal act of the payload. This status of the focal act is the final state of the state transition. This can be either a request or a command, according to the mood of the control act.Naturally occurring, processed or manufactured entities that are primarily used as food for humans and animals.An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.The territory of a sovereign nation.Relates a place (playing Entity) as the location where a living subject (scoping Entity) was born.A ratio quantity is a quantity constructed through division of a numerator quantity with a denominator quantity. Ratios are different from rational numbers, i.e., in ratios common factors in the numerator and denominator never cancel out. A ratio of two real or integer numbers is not automatically reduced to a real number.
The purpose of the ratio data type is to support certain quantities produced by laboratories, such as titers (e.g., "1:128"). Ratios are not simply "structured numerics", blood pressure measurements (e.g. "120/60") are not ratios.Any thing that has extension in space and mass, may be of living or non-living origin.A role played by an entity that has been exposed to a person or animal suffering a contagious disease, or with a location from which a toxin has been distributed. The player of the role is normally a person or animal, but it is possible that other entity types could become exposed. The role is scoped by the source of the exposure, and it is quite possible for a person playing the role of exposed party to also become the scoper a role played by another person. That is to say, once a person has become infected, it is possible, perhaps likely, for that person to infect others.
Management of exposures and tracking exposed parties is a key function within public health, and within most public health contexts - exposed parties are known as "contacts."Physical Quantity Representation: An extension of the coded value data type representating a physical quantity using a unit from any code system. Used to show alternative representation for a physical quantity.General Timing Specification: A <dt-TS>, specifying the timing of events and actions and the cyclical validity-patterns that may exist for certain kinds of information, such as phone numbers (evening, daytime), addresses (so called "snowbirds," residing closer to the equator during winter and farther from the equator during summer) and office hours.A role played by an entity, usually an organization that is the sponsor of an insurance plan or a health program. A sponsor is the party that is ultimately accountable for the coverage by employment contract or by law. A sponsor can be an employer, union, government agency, or association. Fully insured sponsors establish the terms of the plan and contract with health insurance plans to assume the risk and to administer the plan. Self-insured sponsors delegate coverage administration, but not risk, to third-party administrators. Program sponsors designate services to be covered in accordance with statute. Program sponsors may administer the coverage themselves, delegate coverage administration, but not risk to third-party administrators, or contract with health insurance plans to assume the risk and administrator a program. Sponsors qualify individuals who may become
1. a policy holder of the plan;
2. where the sponsor is the policy holder, who may become a subscriber or a dependent to a policy under the plan; or
3. where the sponsor is a government agency, who may become program eligibles under a program.
The sponsor role may be further qualified by the SponsorRole.code. Entities playing the sponsor role may also play the role of a Coverage Administrator.
Example: An employer, union, government agency, or association.Citizen of apolitical entityThe gender of a person used for adminstrative purposes (as opposed to clinical gender)The record target indicates whose medical record holds the documentation of this act. This is especially important when the subject of a service is not the patient himself.Protege 3.2 OWL Ontology for HL7 RIM v 3. Based on documents in HLV3 Ballot May 2006An Entity (player) for which someone (scoper) is granted by law the right to call the material (player) his own. This entitles the scoper to make decisions about the disposition of that material.State of EntityA role played by a material entity that is a specimen for an act. It is scoped by the source of the specimen.A telecommunication address is a locator for some resource (information or services) mediated by telecommunication equipment. The semantics of a telecommunication address is that a communication entity responds to that address (the responder.) and therefore can be contacted by a communication initiator.
The responder of a telecommunication address may be an automatic service that can respond with information (e.g., FTP or HTTP services.) In such case a telecommunication address is a reference to that information accessible through that address. A telecommunication address value can thus be resolved to some information (in the form of encoded data, ED.)
A given telecommunication address value may have limited validity through time and may be tagged by a use code to indicate under what circumstances a specific telecommunication address may be preferred among a set of alternatives.
The telecommunication address is an extension of the Universal Resource Locator (URL) that specifies as an Internet standard RFC 1738 [http://www.isi.edu/in-notes/rfc1738.txt]. The URL specifies the protocol and the contact point defined by that protocol for the resource. Notable uses of the telecommunication address data type are for telephone and telefax numbers, e-mail addresses, Hypertext references, FTP references, etc.A material (player) distributed by a distributor (scoper) who functions between a manufacturer and a buyer or retailer.A role a product plays when a guarantee is given to the purchaser by the seller (scoping entity) stating that the product is reliable and free from known defects and that the seller will repair or replace defective parts within a given time limit and under certain conditions.The act is the focal point of information assembled in response to the occurrence of a "controlled event." "Participations" and "Acts" related to a "controlled event" ard assembled in a package with the RIM content that a domain technical committee specifies as the main payload of information to be communicated to document the event. This package can be placed in a message envelope, directed to an application managing documents or any application with component interfaces to this package of structured information content.
OpenIssue: Look at the symmetry between how messages and documents are structured. This is work that is yet to be completed.collects roles in which the playing entity is in some sense a "part" of the scoping entity.A person having referred the subject of the service to the performer (referring physician). Typically, a referring physician will receive a report.A role played by an entity, usually an organization, that is the sponsor of a clinical research trial or study. The sponsor commissions the study, bears the expenses, is responsible for satisfying all legal requirements concerning subject safety and privacy, and is generally responsible for collection, storage and analysis of the data generated during the trial. No scoper is necessary, as a clinical research sponsor undertakes the role on its own authority and declaration. Clinical research sponsors are usually educational or other research organizations, government agencies or biopharmaceutical companies.Integer numbers are precise numbers that are results of counting and enumerating. Integer numbers are discrete, the set of integers is infinite but countable. No arbitrary limit is imposed on the range of integer numbers. Two exceptional values are defined for the positive and negative infinity.Regions of Interest (ROI) within a subject Act. Primarily used for making secondary observations on a subset of a subject observation. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type "subject" (SUBJ), which must always be present.Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.The Boolean type stands for the values of two-valued logic. A Boolean value can be either "true" or "false". With any data value potentially being NULL, the two-valued logic is effectively extended to a three-valued logic.A stabilizer (player) added to a mixture (scoper) in order to prevent the molecular disintegration of the main substance.Specifies the administrative functionality within a formal experimental design for which the ResearchSubject role was established.
Examples: Screening - role is used for pre-enrollment evaluation portion of the design; enrolled - role is used for subjects admitted to the experimental portion of the design.The set of actions that define an experiment to assess the effectiveness and/or safety of a biopharmaceutical product (food, drug, device, etc.). In definition mood, this set of actions is often embodied in a clinical trial protocol; in event mood, this designates the aggregate act of applying the actions to one or more subjects.The act of examining and evaluating the subject, usually another act. For example, "This prescription needs to be reviewed in 2 months."A person, non-person living subject, or place that is the subject of an investigation related to a notifiable condition (health circumstance that is reportable within the applicable public health jurisdiction)Things or combination of things transformed for a particular purpose by a non-natural or manufacturing process. This class encompasses containers, devices, software modules and facilities.A person responsible for the primary care of a patient at home.A monetary amount is a quantity expressing the amount of money in some currency. Currencies are the units in which monetary amounts are denominated in different economic regions. While the monetary amount is a single kind of quantity (money) the exchange rates between the different units are variable. This is the principle difference between physical quantity and monetary amounts, and the reason why currency units are not physical units.
Equality of two monetary amounts -- unlike physical quantities -- is determined as the joint equality of their value and currency properties independently. If the currencies are not equal, the amounts cannot be compared. Conversion between the currencies is outside the scope of this specification. In practice, foreign exchange rates are highly variable not only over long and short amounts of time, but also depending on location and access to currency trade markets.HL7 Reserved Identifier SCheme: A globally unique string defined exclusively by HL7. Identifiers in this scheme are only defined by balloted HL7 specifications. Local communities or systems must never use such reserved identifiers based on bilateral negotiations.
HL7 reserved identifiers are strings that consist only of (US-ASCII) letters, digits and hyphens, where the first character must be a letter. HL7 may assign these reserved identifiers as mnemonic identifiers for major concepts of interest to HL7.All single celled living organisms including protozoa, bacteria, yeast, viruses, etc.A value that contains other discrete (but not necessarily distinct) values in a defined sequence. sameAs rdf:ListThe role of an organization or individual designated to receive payment for a claim against a particular coverage. The scoping entity is the organization that is the submitter of the invoice in question.A physical quantity is a dimensioned quantity expressing the result of a measurement act and are represented as pairs of value and unit. However, semantically, a physical quantity is more than a pair of value and unit. To find out whether two physical quantities are equal, it is not enough to compare equality of their two values and units independently. For example, semantically 100 cm equals 1 m although neither values nor units are equal. To define equality we introduce the notion of a canonical form.
Every physical quantity has a canonical form. The canonical form is a physical quantity expressed as a pair of value and unit such that each dimension in a given unit system has one and only one canonical value-unit pair. Defining the canonical form is not subject of this specification, only asserting that such a canonical form exists for every physical quantity. A physical quantity is equal to its canonical form.
For example, for a unit system based on the Syst�me International (SI) one can define the canonical form as (a) the product of only the base units; (b) without prefixes; where (c) only multiplication and exponents are used (no division operation); and (d) where the seven base units appear in a defined ordering (e.g., m, s, g, ...) Thus, 1 mm Hg would be expressed as 133322 m-1.s-2.g. As can be seen, the rules how to build the canonical form of units may be quite complex. However, for the semantic specification it doesn�t matter how the canonical form is built, nor what specific canonical form is chosen, only that some canonical form could be defined.
Two physical quantities are equal if each their values and their units of their canonical forms are equal.
Two physical quantities compare each other (and have an ordering and difference) if the units of their canonical forms are equal.A battery specifies a set of observations. These observations typically have a logical or practical grouping for generally accepted clinical or functional purposes, such as observfations that are fun together because of automation. A battery can define required and optional components and, in some cases, will define complex rules that determine whether or not a particular observation is made. Examples include "Blood pressure", "Full blood count", "Chemistry panel".A non-mandated intent to perform an act where a level of professional responsibility is being accepted by making the proposal.A clinical document that conforms to Level One of the HL7 Clinical Document Architecture (CDA)Unique identifier String (UID): A unique identifier string is a character string which identifies an object in a globally unique and timeless manner. The allowable formats and values and procedures of this data type are strictly controlled by HL7. At this time, user-assigned identifiers may be certain character representations of ISO Object Identifiers (OID) and DCE Universally Unique Identifiers (UUID). HL7 also reserves the right to assign other forms of UIDs (RUID), such as mnemonic identifiers for code systems.
The sole purpose of UID is to be a globally and timelessly unique identifier. The form of UID, whether it is an OID, a UUID or a RUID, is entirely irrelevant. As far as HL7 is concerned, the only thing one can do with a UID is denote to the object for which it stands. Comparison of UIDs is literal, i.e. if two UIDs are literally identical, they are assumed to denote to the same object. If two UIDs are not literally identical they may not denote to the same object.A source of reported information (e.g., a next of kin who answers questions about the patient's history). For history questions, the patient is logically an informant, yet the informant of history questions is implicitly the subject.The Instance Identifier (II) data type is used to uniquely identify an instance, thing or object. Examples are object identifier for HL7 RIM objects, medical record number, order id, service catalog item id, etc. Instance identifiers are defined based on ISO object identifiers.A party that originates the Act and therefore has responsibility for the information given in the Act and ownership of this Act. Example: the report writer, the person writing the act definition, the guideline author, the placer of an order, the EKG cart (device) creating a report etc. Every Act should have an author. Authorship is regardless of mood always actual authorship. The author (or authors) has ownership of the Acts that they originate. This means that a party other than this author (or those authors) cannot cancel, abort, complete or modify the state or content of this Act in any other way. A party other than the author may only amend, reverse, override, replace, or follow up in other ways on this Act, whereby the Act remains intact and is linked to another Act authored by that other party.Specialization of Act to add the characteristics unique to document management services.Indicates that the subject Act has undergone or should undergo substitution of a type indicated by Act.code.
Used to specify "allowed" substitution when creating orders, "actual" susbstitution when sending events, as well as the reason for the substitution and who was responsible for it.UncertainValueProbabilistic . This is a generic data type extension to specify one uncertain value tagged with a probability. The probability expresses the information producer�s belief that the given value holds. How the probability number was arrived at is outside the scope of this specification.
Probabilities are subjective and (as any pieces of data) apply in a context. The context of any data item is the data structure in which that item appears. While the context dependence is important for any information, it is critical to understand the context dependency of probabilities: when new information is found the probability might change. Thus, for any message (document, or other information representation) the information -- and particularly the probabilities -- reflects what the information producer believed was appropriate at the given time and for the given purpose for which the message (document) was created.
Since probabilities are subjective measures of belief, they can be stated without being "correct" or "incorrect" per se, let alone "precise" or "imprecise". Notably, one does not have to entertain experiments to measure a frequency of some outcome in order to specify a probability. In fact, whenever statements about individual people or events are made, it is not possible to confirm such probabilities with "frequentists" experiments.
The type T is not formally constrained. In theory, discrete probabilities can only be stated for discrete data values. Thus, generally UVP<REAL> and UVP<PQ> values should not be stated. However, by definition a discrete value set is one that is finite or countably infinite, and abiding by this definition any measured value or real number recorded with digits is discrete. Thus, the distinction between discrete and continuous values is not practical for our purpose. Indeed, even though integer numbers are discrete (countably infinite) estimating a single integer number and tagging it with a probability is not reasonable. Most textbook on statistics treat estimations of integers or ordinals as real numbers when defining the estimated value of a random sample X as the sum of x * p(x) over all x in X.HL7 VocabularyA group of entries within a composition or topic that have a common characteristic - for example, Examination, Diagnosis, Management OR Subjective, Objective, Analysis, Plan.
The distinction from Topic relates to value sets. For Category there is a bounded list of things like "Examination", "Diagnosis" or SOAP categories. For Topic the list is wide open to any clinical condition or reason for a part of an encounter.The person (or organization) who receives the product of an Act.A public health case is an Observation representing a condition or event that has a specific significance for public health. Typically it involves an instance or instances of a reportable infectious disease or other condition. The public health case can include a health-related event concerning a single individual or it may refer to multiple health-related events that are occurrences of the same disease or condition of interest to public health. An outbreak involving multiple individuals may be considered as a type of public health case. A public health case definition (Act.mood_cd = "definition") includes the description of the clinical, laboratory, and epidemiologic indicators associated with a disease or condition of interest to public health. There are case definitions for conditions that are reportable, as well as for those that are not. There are also case definitions for outbreaks. A public health case definition is a construct used by public health for the purpose of counting cases, and should not be used as clinical indications for treatment. Examples include AIDS, toxic-shock syndrome, and salmonellosis and their associated indicators that are used to define a case.
OpenIssue: Need to work to broaden the concept, the name and the description.A person entering the data into the originating system. The data entry person is collected optionally for internal quality control purposes. This includes the transcriptionist for dictated text.A group of entries within a composition that are related to a common clinical theme - such as a specific disorder or problem, prevention, screening and provision of contraceptive services.Electronic health record, A context that comprises all compositions. The EHR is an extract that includes the entire chart.A role played by a member of a military service. Scoper is the military service (e.g. Army, Navy, Air Force, etc.) or, more specifically, the unit (e.g. Company C, 3rd Battalion, 4th Division, etc.)Generated Sequence: A periodic or monotone sequence of values generated from a few parameters, rather than being enumerated. Used to specify regular sampling points for biosignals.The data type "Coded with Equivalents" (CE) is a restriction of the concept descriptor (CD). The CE suppresses the CD modifier property, which is not applicable. The CE also restricts the translation property such that the translation is a set of CV values. CV values may not themselves contain translations.
The CE type is used when the use case indicates that alternative codes may exist and where it is useful to communicate these. The CE type provides for a primary code value, plus a set of alternative or equivalent representations.Distributes material used in or generated during the act.An outbreak represents a series of public health cases. The date on which an outbreak starts is the earliest date of onset among the cases assigned to the outbreak, and its ending date is the last date of onset among the cases assigned to the outbreak.A secondary information recipient, who receives copies (e.g., a primary care provider receiving copies of results as ordered by specialist).same as rdfs:Class. Contain distinctive value.
A set is a value that contains other values of a certain data type as its elements. The elements are contained in no particular ordering. All elements in the set are distinct, the same element value cannot be contained more than once in the set.
The primitive semantic property of a set is the contains-relation of elements in the set. On this semantic primitive, all other properties are defined. A set may only contain distinct non-NULL elements. Exceptional values (NULL-values) cannot be elements of a set.
The empty set is a set without any elements. The empty set is a proper set value, not an exceptional (NULL) value. The cardinality of a set is the number of distinct elements in the set.
The cardinality definition is not sufficient since it doesn�t converge for uncountably infinite sets (REAL, PQ, etc.) and it doesn�t terminate for infinite sets. In addition, the definition of integer number type in this specification is incomplete for these cases, as it doesn�t account for infinities. Finally the cardinality value is an example where it would be necessary to distinguish the cardinality aleph0 of countably infinite sets (e.g., INT) from aleph1, the cardinality of uncoutable sets (e.g., REAL, PQ).The role of a person (player) who is the officer or signature authority for of a scoping entity, usually an organization (scoper).A role played by a person or an organization. It is the party that
1.accepts fiscal responsibility for insurance plans and the policies created under those plans;
2. administers and accepts fiscal responsibility for a program that provides coverage for services to eligible individuals; and/or
3. has the responsibility to assess the merits of each risk and decide a suitable premium for accepting all or part of the risk. If played by an organization, this role may be further specified by an appropriate RoleCode.which links two people in a personal relationship.A base ingredient (player) is what comprises the major part of a mixture (scoper). E.g., Water in most i.v. solutions, or Vaseline in salves. Among all ingredients of a material, there should be only one base. A base substance can, in turn, be a mixture.A physicial place or site with its containing structure. May be natural or man-made. The geographic position of a place may or may not be constant.Target that is substantially present in the service and which is directly affected by the service action (includes consumed material, devices, etc.).Event-related periodic interval of time: Specifies a periodic interval of time where the recurrence is based on activities of daily living or other important events that are time-related but not fully determined by time.
For example, "one hour after breakfast" specifies the beginning of the interval at one hour after breakfast is finished. Breakfast is assumed to occur before lunch but is not determined to occur at any specific time.Working_list collects a dynamic list of individual instances of Act via Act_relationship which reflects the need of an individual worker, team of workers, or an organization to manage lists of acts for many different clinical and administrative reasons. Examples of working lists include problem lists, goal lists, allergy lists, and to-do lists.
OpenIssue: The name is too generic. This needs to be harmonized with Scheduling.In an obstetric service, the baby.MaleA relationship in which the scoper certifies the player ( e. g. a medical care giver, a medical device or a provider organization) to perform certain activities that fall under the jurisdiction of the scoper (e.g., a health authority licensing healthcare prlviders, a medical quality authority certifying healthcare professionals,)A service that actually happens, may be an ongoing service or a documentation of a past service.A verifier who attests to the accuracy of an act, but who does not have privileges to legally authenticate the act. An example would be a resident physician who sees a patient and dictates a note, then later signs it. Their signature constitutes an authentication.Any of the above service moods (e.g., event, intent, or goal) can be turned into a predicate used as a criterion to express conditionals (or queries.) However, currently we allow only criteria on service events.A substance (player) influencing the optical aspect of material (scoper).An intent to perform a service that has the strength of a commitment, i.e., other parties may rely on the originator of such promise that said originator will see to it that the promised act will be fulfilled. A promise can be either solicited or unsolicited.layer of the Affiliate role has a business/professional relationship with scoper. Player and scoper may be persons or organization. The Affiliate relationship does not imply membership in a group, nor does it exist for resource scheduling purposes.A transformation process where a requested invoice is transformed into an agreed invoice. Represents the adjudication processing of an invoice (claim). Adjudication results can be adjudicated as submitted, with adjustments or refused.
Adjudication results comprise 2 components: the adjudication processing results and a restated (or adjudicated) invoice or claimAn Entity that is authorized to issue or instantiate permissions, privileges, credentials or other formal/legal authorizations.Periodic Interval of Time: An interval of time that recurs periodically. PIVL has two properties, phase and period. phase specifies the "interval prototype" that is repeated every ..The practitioner that has responsibility for overseeing a patient's care during a patient encounter.A concept descriptor represents any kind of concept. The CD refers to a concept usually by citing a code defined in a coding system. A given concept may be expressed in multiple terms where each term is a translation or re-encoding of the meaning in another code system. In addition (and different from translations) compositional code systems are supported. In exceptional cases, the concept descriptor may not contain a code but only free text describing that concept. The CD is typically used through one of its restrictionsA context representing a grouped commitment of information to the EHR. It is considered the unit of modification of the record, the unit of transmission in record extracts, and the unit of attestation by authorizing clinicians.
A composition represents part of a patient record originating from a single interaction between an authenticator and the record.
Unless otherwise stated all statements within a composition have the same authenticator, apply to the same patient and were recorded in a single session of use of a single application.
A composition contains organizers and entries.Parties that may or should contribute or have contributed information to the Act. Such information includes information leading to the decision to perform the Act and how to perform the Act (e.g., consultant), information that the Act itself seeks to reveal (e.g., informant of clinical history), or information about what Act was performed (e.g., informant witness).A formalized group of people with a common purpose (e.g. administrative, legal, political) and the infrastructure to carry out that purpose. Examples include companies and institutions, a government department, an incorporated body that is responsible for administering a facility, an insurance company.A context that subdivides the body of a document. Document sections are typically used for human navigation, to give a reader a clue as to the expected content. Document sections are used to organize and provide consistency to the contents of a document body. Document sections can contain document sections and can contain entries.BinaryData. All communicated information must ultimately be physically encoded as binary data. Binary data is the most primitive yet the omnipotent encoding of all information.
Binary data is a sequence of uninterpreted bits. A bit is identical with a Boolean value. Thus, all binary data is semantically a sequence of Boolean values. The binary data type is protected, it should not be used directly but only inside the encoded data (ED) type described below.
ITS Note: the representation of arbitrary binary data is the responsibility of an ITS. How the ITS accomplishes this depends on the underlying Implementation Technology (whether it is character-based or binary) and on the so represented data. Semantically character data is represented as binary data, however, a character-based ITS should not convert character data into arbitrary binary data and then represent binary data in a character encoding. Ultimately even character-based implementation technology will communicate binary data.
It follows from the definition of the sequence generic type (LIST) that an "empty" sequence of binary data is not a valid value but counts as a NULL-value. In other words, non-NULL binary data contains at least one bit.Expectation to make a specific observation with a desired value at a predefined future timeThe molecule or ion that is responsible for the intended pharmacological action of the drug substance, excluding those appended or associated parts of the molecule that make the molecule an ester, salt (including a salt with hydrogen or coordination bonds), or other noncovalent derivative (such as a complex, chelate, or clathrate).
Examples: heparin-sodium and heparin-potassium have the same active moiety, heparin; the active moiety of morphine-hydrochloride is morphine.The practitioner who is responsible for the discharge of a patient from a patient encounterT is one particular data type. Used to type generic parameters and to provide an extension base. T is a restriction of ANY to one particular type.Diet acts are supply acts, with some aspects resembling Substance_administration acts: the detail of the diet is given as a description of the Material associated via Participation.type_cd="product". Medically relevant diet types may be communicated in the Entity.cd, however, the detail of the food supplied and the various combinations of dishes should be communicated as Material instances.Container for Observation Sequences (Observations whose values are contained in LIST<>'s) having values correlated with each other. Each contained Observation Sequence LIST<> must be the same length. Values in the LIST<>'s are correlated based on index. E.g. the values in position 2 in all the LIST<>'s are correlated. This is analogous to a table where each column is an Observation Sequence with a LIST<> of values, and each row in the table is a correlation between the columns. For example, a 12-lead ECG would contain 13 sequences: one sequence for time, and a sequence for each of the 12 leads.Sender asks addressee to do something depending on the focal Act of the payload. An example is "fulfill this order". Addressee has responsibilities to either reject the message or to act on it in an appropriate way (specified by the specific receiver responsibilities for the interaction).Real numbers are the superset of integer numbers, rational numbers, and irrational numbers. Real numbers are needed beyond integers whenever quantities of the real world are measured, estimated, or computed from other real numbers.A device that does not change ownership due to the service, i.e., a surgical instrument or tool or an endoscope. The distinction between reuseable and non-reuseable must be made in order to know whether material must be re-stocked.Participant who posses an instrument such as a financial contract (insurance policy) usually based on some agreement with the author.A device that changes ownership due to the service, e.g., a pacemaker, a prosthesis, an insulin injection equipment (pen), etc. Such material may need to be restocked after he service.A health chart included to serve as a document receiving entity in the management of medical records.A manufactured material (player) that is used for its therapeutic properties. The manufacturer is the scoper.An individual designated for notification as the next of kin for a given entity.The Coded Value (CV) is a restriction of the concept descriptor (CD). The CV suppresses the CD properties translation and modifier, which are both not applicable. The CV also constrains the original text to a character string (ST) instead of the more general encapsulated data (ED) type.
This type is used when any reasonable use case will require only a single code value to be sent. Thus, it should not be used in circumstances where multiple alternative codes for a given value are desired. This type may be used with both the CNE and the CWE domain qualifier.A general association between two entities that is neither partitive nor ontological.A role of a place (player) that is intended to house the provision of services. Scoper is the Entity (typically Organization) that provides these services. This is not synonymous with "ownership."Substance_administration is an Act using a Material as a therapeutic agent. The effect of the therapeutic substance is typically established on a biochemical basis, however, that is not a requirement. For example, radiotherapy can largely be described in the same way, especially if it is a systemic therapy such as radio-iodine.Relates a component (player) to a mixture (scoper). E.g., Glucose and Water are ingredients of D5W, latex may be an ingredient in a tracheal tube.This context represents the part of a patient record conveyed in a single communication. It is drawn from a providing system for the purposes of communication to a requesting process (which might be another repository, a client application or a middleware service such as an electronic guideline engine), and supporting the faithful inclusion of the communicated data in the receiving system.
An extract may be the entirety of the patient record as held by the sender or it may be a part of that record (e.g. changes since a specified date).
An extract contains folders or compositions.An entity that is the subject of an investigation. This role is scoped by the party responsible for the investigation.An anticipated act.An action taken with respect to a subject Entity by a regulatory or authoritative body with supervisory capacity over that entity. The action is taken in response to behavior by the subject Entity that body finds to be undesirable.
Suspension, license restrictions, monetary fine, letter of reprimand, mandated training, mandated supervisionThe principal or primary performer of the act.Sampled Sequence: A sequence of sampled values scaled and translated from a list of integer values. Used to specify sampled biosignals.An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.An interaction between a patient and healthcare participant(s) for the purpose of providing patient service(s) or assessing the health status of a patient. For example, outpatient visit to multiple departments, home health support (including physical therapy), inpatient hospital stay, emergency room visit, field visit (e.g., traffic accident), office visit, occupational therapy, telephone call.
OpenIssue: States of patient encounter (#234).A person who actually and principally carries out the action. Need not be the principal responsible actor, e.g. a surgery resident operating under supervision of attending surgeon, and may be the patient in self-care, e.g. fingerstick blood sugar. The traditional order filler is a performer. This information should accompany every service event.An act which describes the process whereby a 'verifying party' validates either the existence of the Role attested to by some Credential or the actual Vetting act and its details.A politically organized body of people bonded by territory and known as a nation.which are roles in which the playing entity is used, known, treated, handled, built, or destroyed, etc. under the auspices of the scoping entity. The playing entity is passive in these roles in that the role exists without an agreement from the playing entity.A product regulated by some governmentatl orgnization. The role is played by Material and scoped by Organization.
Rationale: To support an entity clone used to identify the NDC number for a drug product.A sub-class of Act representing any transaction between two accounts whose value is measured in monetary terms.
In the "intent" mood, communicates a request for a transaction to be initiated, or communicates a transfer of value between two accounts.
In the "event" mood, communicates the posting of a transaction to an account.An entity to be contacted in the event of an emergency.The role of an organization that undertakes to accept claims invoices, assess the coverage or payments due for those invoices and pay to the designated payees for those invoices. This role may be either the underwriter or a third-party organization authorized by the underwriter. The scoping entity is the organization that underwrites the claimed coverage.The role of a material (player) that is the physical health chart belonging to an organization (scoper).Only with Transportation services. A person who escorts the patient.11A class or specific instance of a physical thing or an organization/group of physical things capable of participating in Acts; an artifact. This includes living subjects, organizations, material, and places.
The Entity hierarchy encompasses human beings, organizations, living organisms, devices, pharmaceutical substances, etc. It does not include events/acts/actions, or the roles that things can play (e.g. patient, provider).111111A planned Act for a specific time and place.An observation identifying a potential adverse outcome as a result of an Act or combination of Acts.
Examples: Detection of a drug-drug interaction; Identification of a late-submission for an invoice; Requesting discharge for a patient who does not meet hospital-defined discharge criteria.Character String, The character string is a restricted encoded data type (ED), whose type property is fixed to text/plain, and whose data must be inlined and not compressed. Thus, the properties compression, reference, integrity check, algorithm, and thumbnail are not applicable. The character string data type is used when the appearance of text does not bear meaning, which is true for formalized text and all kinds of names.
The character string (ST) data type interprets the encoded data as character data (as opposed to bits), depending on the charset property of the encoded data type.
because many of the properties of the encoded data are bound to a default value, an ITS need not represent these properties at all. In fact, if the character encoding is also fixed, the ITS only represents the encoded character data.
ISO/IEC 10646-1: 1993 defines a character as "A member of a set of elements used for the organization, control, or representation of data." ISO/IEC TR 15285 " An operational model for characters and glyphs. Discusses the problems involved in defining characters. Notably, characters are abstract entities of information, independent of type font or language. The ISO 10646 (UNICODE [http://www.unicode.org]) " or in Japan, JIS X0221 " is a globally applicable character set that uniquely identifies all characters of any language in the world.
In this specification, ISO 10646 serves as a semantic model for character strings. The important point is that for semantic purposes, there is no notion of separate character sets and switching between character sets. Character set and character encoding are ITS layer considerations. The formal definition gives indication to this effect because each character is by itself an ST value that has a charset property. Thus, the binary encoding of each character is always understood in the context of a certain character set. This does not mean that the ITS should represent a character string as a sequence of full blown ED values. What it means is that on the application layer the notion of character encoding is irrelevant when we deal with character strings.
The length of a string is the number of characters, not the number of encoded bytes. Byte encoding is an ITS issue and is not relevant on the application layer.An formalized inquiry into the circumstances surrounding a particular unplanned event or potential event for the purposes of identifying possible causes and contributing factors for the event. This investigation could be conducted at a local institutional level or at the level of a local or national government.Encapsulated Data, The encoded data type can convey any data. However, in order for that data to convey meaning, encoded data must be decoded and further interpreted. Encoded data may be a plain character string, formatted text, or any of several kinds of multimedia data. The kind of encoding is conveyed in three properties:
1. type - specifies the protocol, or application used to decode and interpret the data (also known as the "media type" as referring to multi-media data.)
2. charset - identifies the character set and character encoding for character-based "media."
3. compression - data may be given in a compressed form in which case compression identifies the compression algorithm used.
Encoded data can be present in two forms, inline or by reference. Inline data is communicated or moved as part of the encoded data value, whereas by-reference data may reside at a different (remote) location. The data is the same whether it is located inline or remote.Set of data of "point of time" TS typeThe target participation for an individual in a health care coverage act in which the target role is either the policy holder of the coverage, or a covered party under the coverage.An advisor participating in the service by performing evaluations and making recommendations.The practitioner who is responsible for admitting a patient to a patient encounterAn instance of Observation of a Condition at a point in time that includes any Observations or Procedures associated with that Condition as well as links to previous instances of Condition Node for the same ConditionA microorganism that has been isolated from other microorganisms or a source matrix.Class to contain unique attributes of diagnostic imaging equipment.Information recipient to whom an act statement is primarily directed. E.g., a primary care provider receiving a discharge letter from a hospitalist, a health department receiving information on a suspected case of infectious disease. Multiple of these participations may exist on the same act without requiring that recipients be ranked as primary vs. secondary.A role played by a provider, always a person, who has agency authority from a Clinical Research Sponsor to direct the conduct of a clinical research trial or study on behalf of the sponsor.A grouping of resources (personnel, material, or places) to be used for scheduling purposes. May be a pool of like-type resources, a team, or combination of personnel, material and places.Container for Correlated Observation Sequences sharing a common frame of reference. All Observations of the same cd must be comparable and relative to the common frame of reference. For example, a 3-channel ECG device records a 12-lead ECG in 4 steps (3 leads at a time). Each of the separate 3-channel recordings would be in their own "OBSCOR". And, all 4 OBSCOR would be contained in one OBSSER because all the times are relative to the same origin (beginning of the recording) and all the ECG signals were from a fixed set of electrodes.An entity name part is a character string token that may have a type code signifying the role of the part in the whole entity name. Typical name parts that exist in about every name are given names, and family names, titles, etc.The principle target that the service acts on. E.g. the patient in physical examination, a specimen in a lab observation. May also be a patient's family member (teaching) or a device or room (cleaning, disinfecting, housekeeping). Note: not all direct targets are subjects, consumables, and devices used as tools for a service are not subjects. However, a device may be a subject of a maintenance service.A context representing the high-level organization of an extract e.g. to group parts of the record by episode, care team, clinical specialty, clinical condition, or source application. Internationally, this kind of organizing structure is used variably: in some centers and systems the folder is treated as an informal compartmentalization of the overall health record; in others it might represent a significant legal portion of the EHR relating to the originating enterprise or team.Relates a place entity (player) as the region over which the scoper (typically an Organization) has certain authority (jurisdiction). For example, the Calgary Regional Health Authority (scoper) has authority over the territory "Region 4 of Alberta" (player) in matters of health.same as rdf:Bag, An unordered collection of values, where each value can be contained more than once in the collection.A role played by an entity that is a member of a group. The group provides the scope for this role.A relationship between a person or organization and a person or organization formed for the purpose of exchanging work for compensation. The purpose of the role is to identify the type of relationship the employee has to the employer, rather than the nature of the work actually performed. (Contrast with Assigned_entity)constrains the boolean type so that the value may not be NULL. This type is created for use within the data types specification where it is not appropriate for a null value to be usedA non-human living subject..Only with service events. A person witnessing the action happening without doing anything. A witness is not necessarily aware, much less approves of anything stated in the service event. Example for a witness is students watching an operation or an advanced directive witness.Something used in delivering the service without being substantially affected by the service (i.e. durable or inert with respect to that particular service.) Examples are: monitoring equipment, tools, but also access/drainage lines, prostheses, pace maker, etc.An individual human being.An identified point during a clinical trial at which one or more actions are scheduled to be performed (definition mood), or are actually performed (event mood). The actions may or may not involve an encounter between the subject and a healthcare professional.A physical artifact that stores information about the granting of authorization.A role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.possible values for actMoodCd propertyAn officially or unofficially instituted program to track acts of a particular type or categorization.Relates an entity (player) (e.g. a device) to a location (scoper) at which it is normally found or stored when not used.The target person or organization contractually recognized by the issuer as a participant who has assumed fiscal responsibility for another personaTMs financial obligations by guaranteeing to pay for amounts owed to a particular accountA Region of Interest (ROI) specified for a multidimensional observation, such as an Observation Series (OBSSER). The ROI is specified using a set of observation criteria, each delineating the boundary of the region in one of the dimensions in the multidimensional observation. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type subject (SUBJ), which must always be present. Each of the boundary criteria observations is connected with the ROI using ActRelationships of type "has component" (COMP). In each boundary criterion, the Act.code names the dimension and the Observation.value specifies the range of values inside the region. Typically the bounded dimension is continuous, and so the Observation.value will be an interval (IVL) data type. The Observation.value need not be specified if the respective dimension is only named but not constrained. For example, an ROI for the QT interval of a certain beat in ECG Lead II would contain 2 boundary criteria, one naming the interval in time (constrained), and the other naming the interval in ECG Lead II (only named, but not constrained).An entity (person, organization or device) that is in charge of maintaining the information of this act (e.g., who maintains the report or the master service catalog item, etc.).Encompasses the expected states of a service object, but excludes "nullified" and "obsolete" which represent unusual terminal states for the life-cycle.An agency of the people of a state often assuming some authority over a certain matter. Includes government, governmental agencies, associations.A person or organization (player) that serves as a financial guarantor for another person or organization (scoper).An option is an alternative set of property-value bindings. Options specify alternative sets of values, typically used in definitions or orders to describe alternatives. An option can only be used as a group, that is, all assigned values must be used together.A relationship that is based on mutual behavior of the two Entities as being related. The basis of such relationship may be agreements (e.g., spouses, contract parties) or they may be de facto behavior (e.g. friends) or may be an incidental involvement with each other (e.g. parties over a dispute, siblings, children).A living subject from the animal kingdom.A role class played by a person who receives benefit coverage under the terms of a particular insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy.An accommodation is a service provided for a Person or other LivingSubject in which a place is provided for the subject to reside for a period of time. Commonly used to track the provision ofObservations are actions performed in order to determine an answer or result value. Observation result values (Observation.value) include specific information about the observed object. The type and constraints of result values depend on the kind of action performed.
Clinical documents commonly have 'Subjective' and 'Objective' findings, both of which are kinds of Observations. In addition, clinical documents commonly contain 'Assessments', which are also kinds of Observations. Thus, the establishment of a diagnosis is an Observation.History_item. This generic data type extension is tags a time range to its base data value. The time range is the time in which that data was, is, or is expected to be valid. If the base type T does not possess a valid time property, the HXIT<T> adds that property to the base type. If, however, the base type T does have a valid time property, that property can be mapped to the valid time property of the HXIT<T>.
Note that data types are specifications of abstract properties of values. This specification does not mandate how these values are represented in an ITS or implemented in an application. Specifically, it does not mandate how the represented components are named or positioned. In addition, the semantic generalization hierarchy may be different from a class hierarchy chosen for implementation (if the implementation technology has inheritance.) Keep the distinction between a type (interface) and an implementation (concrete data structure, class) in mind. The ITS must contain a mapping of ITS defined features of any data type to the semantic properties defined here.A request or order for a service is an intent directed from a placer (request author) to a fulfiller (service performer).
Rationale: The concepts of a "request" and an "order" are viewed as different, because there is an implication of a mandate associated with order. In practice, however, this distinction has no general functional value in the inter-operation of health care computing. "Orders" are commonly refused for a variety of clinical and business reasons, and the notion of a "request" obligates the recipient (the fulfiller) to respond to the sender (the author). Indeed, in many regions, including Australia and Europe, the common term used is "request."
Thus, the concept embodies both notions, as there is no useful distinction to be made. If a mandate is to be associated with a request, this will be embodied in the "local" business rules applied to the transactions. Should HL7 desire to provide a distinction between these in the future, the individual concepts could be added as specializations of this concept.
The critical distinction here, is the difference between this concept and an "intent", of which it is a specialization. An intent involves decisions by a single party, the author. A request, however, involves decisions by two parties, the author and the fulfiller, with an obligation on the part of the fulfiller to respond to the request indicating that the fulfiller will indeed fulfill the request.A material target that is brought forth (produced) in the service (e.g., specimen in a specimen collection, access or drainage in a placement service, medication package in a dispense service). It doesn't matter whether the material produced had existence prior to the service, or whether it is created in the service (e.g., in supply services the product is taken from a stock).An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).Scoped by the manufacturerAn intention or plan to perform a service. Historical note: in previous RIM versions, the intent mood was captured as a separate class hierarchy, called Service_intent_or_order.Character String with Code: A character string that optionally may have a code attached. The text must always be present if a code is present. The code is often a local code.A portion (player) of an original or source specimen (scoper) used for testing or transportation.A container is a manufactured material used to hold other things for purposes such as transportation or protection of contents from loss or damage. With amorphic substances (liquids, gases) a container is required. However, the content of a container is always distinguishable and relatively easily separable from the container, unlike the content (ingredient) of a mixture.
A container is related to a content material through Role_relationship.type_cd = "has content".
Rationale: The specifications for this class arose from the collaboration between HL7 and the NCCLS. Many of the attribute definitions are drawn from or reference the NCCLS standard.A non-mandated intent to perform an act. Used to record intents that are explicitly not Orders. Professional responsibility for the 'proposal' may or may not be present.A definition of a service (master).Interval of physical quantities: A set of consecutive values of physical quantities.A material (player) that can be administered to an Entity (scoper).An association between a Role and an Act. The Participation represents the involvement of the Entity playing the Role with regard to the associated Act. A single Role may participate in multiple Acts and a single Act may have multiple participating Roles. A single Participation is always an association between a particular Role and a particular Act.
Participation is limited to the scope of the Act, as opposed to Role, which defines the competency of an Entity irrespective of any Act.
Participations are generally grouped into actors and targets. Examples of actors are nurses, doctors, family members, notary publics, and service organizations -- every person or organization that is capable of independent decisions and can thus be responsible (and liable) for the actions performed. Target participants in an act may include the patient, the patient's spouse, family, or community, a specimen drawn from the patient or from any object of interest.
Actors can participate in an action in different ways. For example, primary surgeon, assistant surgeon, sterile nurse, and nurse assistant are all actors in a surgical procedure, who are more or less immediately involved in the action. However, payers, supervisors, provider organizations (e.g., "MicroLab") and their delegates may be actors too, even though they might not be individual persons who have their "hands on" the action.
The notion of multiple actors with specific functions touches and partially overlaps on two "sides" with related concepts of the RIM, and understanding the distinctions is important to use the RIM constructs correctly. On the one "side" actor functions look similar to Roles (e.g., healthcare practitioner, guarantor, contact-person,) and capability and certification (e.g., certified surgeon vs. resident, certified nurse midwife vs. other midwife practitioner, registered nurse vs. other nurse practitioner.) The professional credentials of a person may be quite different from what a person actually does. The most common example is interns and residents performing anesthesia or surgeries under (more or less) supervision of attending specialists. The opposite example is people who are both medical doctors and registered nurses and who perform the function of a nurse. Thus, Roles and certification refer to the static capabilities of a person (person-related) while participating actors refer to the particular function an actor played in the activity.
On the other "side" the actor concept interferes with sub-activities. Whenever multiple actors are involved in an act, each actor performs a different task (with the extremely rare exception of such symmetrical activities as two people pulling a rope from either end.) Thus, the presence of multiple actors could be equally well modeled as an act consisting of sub-acts where each act would have only one performing actor
For example, a record of a surgical service may include the actors of type: (a) consenter, (b) primary surgeon, and (c) anesthetist. These three actors really perform different tasks, which can be represented as three related acts: (a) the consent, (b) the surgery proper, and (c) the anesthesia act in parallel to the surgery. If we used the sub-acts, the consenter, surgeon and anesthetist could simply be of actor type "performer." Thus the more sub-acts we use, the fewer different actor types need to be distinguished, and the fewer sub-acts we use, the more distinct actor types we need.
Note that the perception of a task as "atomic" or "composite" (of sub-tasks) depends on local business rules and may differ from department to department. In principle, every task can be thought of as being a composite of sub-tasks. We thus say that actions are "fractal." The paradigmatic example of the fractal nature of activities is a "robotic arm" doing some simple action as reaching for a tool in front of it. The seemingly simple activity of the robotic arm decomposes into complex control and coordination procedures and movements, action of separate motors and switches, etc. (We sometimes use the key-phrase "robotic arm discussion" to recall the fractal nature of actions, since this example has been brought up over and over again, independently by different people.)
As a rule of thumb, sub-tasks should be considered instead of multiple actors when each sub-task requires special scheduling, or billing, or if overall responsibilities for the sub-tasks are different. In most cases, however, human resources are scheduled by teams (instead of individuals,) billing tends to lump many sub-tasks together into one position, and overall responsibility often rests with one attending physician, chief nurse, or head of department. This model allows both the multi-actor and the muli-act approach to represent the business reality, with a slight bias towards "lumping" minor sub-activities into the overall act.11An action of interest that has happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. An act is an intentional action in the business domain of HL7. Healthcare (and any profession or business) is constituted of intentional actions. An Act instance is a record of such an intentional action.
Any intentional action can exist in different "moods". Moods describe activities as they progress in the business cycle, from defined, through planned and ordered to complete.
Any instance of an Act assumes one and only one mood and will not change its mood along its life cycle. The moods - definition, intent, order, event - seem to specify a life cycle of an activity. However, the participants in the activity in these different moods are different, as is the data. Therefore, the mood of an Act instance is static. The progression actualization (i.e., the progression from defined, through planned and ordered, to being performed) is called the "business cycle" to distinguish it from the "life cycle" of a single act instance. Related Act instances that form such a "business cycle" are linked through the Act_relationship class.
Examples for acts in health care are: a clinical test, an assessment of health condition (such as problems and diagnoses), the setting of healthcare goals, the performance of treatment services (such as medication, surgery, physical and psychological therapy), assisting, monitoring or attending, training and education services to patients and their next of kin, and notary services (such as advanced directives or living will).
Acts have participants, which can be actors or targets. Examples of actors are nurses, doctors, family members, notary publics, and service organizations -- every person or organization that is capable of independent decisions and can thus is responsible (and liable) for the actions performed.
Target participants in an act may include the patient, the patient's spouse, family, or community, a specimen drawn from the patient or from any object of interest. As patients do play active roles in their own healthcare, the patient can be both an active participant and a target participant at the same time (self-administered or reflexive services.)
An act can have multiple active participants and multiple target participants, their specific role being distinguished in the "type_cd" of the respective instance of the Participation class. In particular, an act involving coordination of care may involve two or more active participants -- playing different roles -- who interact on behalf of a patient, family, or aggregate in the role of target participant. For example, a nurse (active participant) calls Meals on Wheels (active participant) on behalf of the patient (target participant).
An act includes the "results", "answers" or informational "procedure products" gained during the act. In this model, "results" do not exist without an act, and every clinical result, including those results gained accidentally, is gleaned via an act. In other moods, such as "definition " or "intent", the results are the possible results, the expected or aimed-for results, or the tested-for results.111111111111Universal Resource Locator: This data type is defined as an Internet standard RFC 1738 [ftp://ftp.isi.edu/in-notes/rfc1738.txt].Target that is taken up, is diminished, and disappears in the service.The gender of a person could not be uniquely defined as male or female, such as hermaphrodite.Interval of point in time: A set of consecutive values of time-stamps.A person or organization who should be contacted for follow-up questions about the act in place of the author.A type of container that can hold other containers or other holders.Class for holding attributes unique to diagnostic images.Represents the act of maintaining information about the registration of its associated registered subject. The subject can be either an Act or a Role, and includes subjects such as lab exam definitions, drug protocol definitions, prescriptions, persons, patients, practitioners, and equipment.A role played by a device when the device is used to administer therapeutic agents (medication and vital elements) into the body, or to drain material (e.g., exudates, pus, urine, air, blood) out of the body. For the most part, anything that would be used for access would be a device (something specifically manufactured or created to serve that purpose). Typically the device is a catheter or cannula inserted into a compartment of the body.
A device enters the body from an anatomic site designated by the approach_site_cd. The body compartment into which material is administered or from which it is drained is designated by the target_site_cd.
Note that the Access role primarily exists in order to describe material actually deployed as an access, and not so much the fresh material as it comes from the manufacturer. For example, in supply ordering a box of catheters from a distributor, it is not necessary to use the Access role class, since the material attributes will usually suffice to describe and identify the product for the order. But the Access role is used to communicate about the maintenance, intake/outflow, and due replacement of tubes and drains.
Devices in the role of an Access are typically used in intake/outflow observations, and in medication routing instructions. Microbiologic observations on the material itself or on fluids coming out of a drain, are also common.
OpenIssue: Issue relates to the restriction of access device to persons or animals as patients. In the case where the material desired does not originate from a "living subject" such as in environmental monitoring, then the access device definition needs to reflect that change. For example, an order for a sample to be taken from the clean-out port of a food processing device for a public health investigation.An Act where a container is registered either via an automated sensor, such as a barcode reader, or by manual receiptCoded Ordinal: Coded data, where the coding system from which the code comes is ordered. CO adds semantics related to ordering so that models that make use of such domains may introduce model elements that involve statements about the order of the terms in a domain.An entity (player) that acts or is authorized to act on behalf of another entity (scoper).A clinical document is a documentation of clinical observations and services, with the following characteristics: (1) Persistence - A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements; (2) Stewardship - A clinical document is maintained by a person or organization entrusted with its care; (3) Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated; (4) Wholeness - Authentication of a clinical document applies to the whole and does not apply to portions of the document without the full context of the document; (5) Human readability - A clinical document is human readable."Calendar Cycle: A calendar cycle defines one group of decimal digits in the calendar expression. Examples for calendar cycles are year, month, day, hour, minute, second, and week.A person who verifies the correctness and appropriateness of the service (plan, order, event, etc.) and hence takes on accountability.Transportation is the moving of a payload (people or material) from a location of origin to a destination location. Thus, any transport service has the three target instances of type payload, origin, and destination, besides the targets that are generally used for any service (i.e., performer, device, etc.)A context that distinguishes the body of a document from the document header. This is seen, for instance, in HTML documents, which have discrete <head> and <body> elements.An entity entering the data into the originating system. The data entry entity is collected optionally for internal quality control purposes. This includes the transcriptionist for dictated text transcribed into electronic form.A person or an organization (player) which provides or receives information regarding another entity (scoper). Examples; patient NOK and emergency contacts; guarantor contact; employer contact.Scoped by a providerTarget that is not substantially present in the act and which is not directly affected by the act, but which will be a focus of the record or documentation of the act.Interval: A set of consecutive values of an ordered base data type.A point in time is a scalar defining a point on the axis of natural time. A point in time is most often represented as a calendar expression. Semantically, however, natural time is independent from calendars. The semantic properties of point in time are best described by its relationship to elapsed time (measured as a physical quantity in the dimension of time.) A point in time plus an elapsed time yields another point in time. Inversely, a point in time minus another point in time yields an elapsed time. As a kind of quantity, points in time are a difference-scale quantity, where no absolute zero-point exists, where only differences are defined but no ratios. For example, no point in time is -- absolutely speaking -- "twice as late" as another point in time.)
Given some arbitrary zero-point, one can express any point in time as an elapsed time measured from that offset. Such an arbitrary zero-point is called an epoch. This epoch-offset form is used as a semantic representation here, without implying that any system would have to implement the TS data type in that way. Systems that do not need to compute distances between points in time will not need any other representation than a calendar expression literal.A procedure for obtaining a specimen from a source entity.An information recipient to notify for urgent matters about this Act. (e.g., in a laboratory order, critical results are being called by phone right away, this is the contact to call; or for an inpatient encounter, a next of kin to notify when the patient becomes critically ill).Sender sends payload to addressee as information. Addressee does not have responsibilities beyond serving addressee's own interest (i.e., read and memorize if you see fit). This is equivalent to an FYI on a memo.The person who receives the patientAn observable finding or state that persists over time and tends to require intervention or management, and, therefore, distinguished from an Observation made at a point in time; may exist before an Observation of the Condition is made or after interventions to manage the Condition are undertaken. Examples: equipment repair status, device recall status, a health risk, a financial risk, public health risk, pregnancy, health maintenance, chronic illnessA verifier who legally authenticates the accuracy of an act. An example would be a staff physician who sees a patient and dictates a note, then later signs it. Their signature constitutes a legal authentication.The territory of a state, province, department or other division of a sovereign country.The territory of a county, parish or other division of a state or provinceFemaleA unit of work, a grouper of work items as defined by the system performing that work. Typically some laboratory order fulfillers communicate references to accessions in their communications regarding laboratory orders. Often one or more specimens are related to an accession such that in some environments the accession number is taken as an identifier for a specimen (group).The principle target that the service acts on. E.g. the patient in physical examination, a specimen in a lab observation. May also be a patient's family member (teaching) or a device or room (cleaning, disinfecting, housekeeping). Note: not all direct targets are subjects, consumables, and devices used as tools for a service are not subjects. However, a device may be a subject of a maintenance service.In some organ transplantation services and rarely in transfusion services a donor will be a target participant in the service. However, in most cases transplantation is decomposed in three services: explantation, transport, and implantation. The identity of the donor (recipient) is often irrelevant for the explantation (implantation) service.An organism or complex animal, alive or not. Instances of this class encompass mammals, birds, fishes, bacteria, parasites, fungi and viruses. Person is a specialization of this class.DCE Universal Unique Identifier: A globally unique string representing a DCE Universal Unique Identifier (UUID) in the common UUID format that consists of 5 hyphen-separated groups of hexadecimal digits having 8, 4, 4, 4, and 12 places respectively.
Both the UUID and its string representation are defined by the Open Group, CDE 1.1 Remote Procedure Call specification, Appendix A.
UUIDs are assigned based on Ethernet MAC addresses, the point in time of creation and some random component. This mix is believed to generate sufficiently unique identifiers without any organizational policy for identifier assignment (in fact this piggy-backs on the organization of MAC address assignment.)
UUIDs are not the preferred identifier scheme for use as HL7 UIDs. UUIDs may be used when identifiers are issued to objects representing individuals (e.g., entity instance identifiers, act event identifiers, etc.) For objects describing classes of things or events (e.g., catalog items), OIDs are the preferred identifier scheme.The "typical" state. Excludes "nullified", which represents the termination state of an Entity instance that was created in errorRelates an entity (player) to a location (scoper) at which it is present in some way. This presence may be limited in time.A kind of service which is authorized to be performed.A politically organized body of people bonded by territory, culture, or ethnicity, having sovereignty (to a certain extent) granted by other states (enclosing or neighboring states). This includes countries (nations), provinces (e.g., one of the United States of America or a French departement), counties or municipalities. Refine using, e.g., ISO country codes, FIPS-PUB state codes, etc.The person or organization that has primary responsibility for the act. The responsible party is not necessarily present in an action, but is accountable for the action through the power to delegate, and the duty to review actions with the performing actor after the fact. This responsibility may be ethical, legal, contractual, fiscal, or fiduciary in nature.A device is anything used in an activity without being substantially changed through that activity. This includes durable (reusable) medical equipment as well as disposable equipment. The kind of device is identified by the Entity.cd.The term "procedure" is also commonly known as a "surgical procedure" or an "operative procedure". Typically, a surgical procedure involves planned alteration of the structure of the body, ordinarily requiring the disruption of some body surface, usually through an incision.The quantity data type is an abstract generalization for all data types (1) whose value set has an order relation (less-or-equal) and (2) where difference is defined in all of the data type�s totally ordered value subsets.
The quantity type abstraction is needed in defining certain other types, such as the interval and the probability distribution.A request for the booking of an appointment.A participant (e.g. provider) who has referred the subject of an act (e.g. patient).Material (player) sold by a retailer (scoper), who also give advice to prospective buyers.Guardian of a wardAn formalized inquiry into the circumstances surrounding a particular unplanned event or potential event for the purposes of identifying possible causes and contributing factors for the event. This investigation could be conducted at a local institutional level or at the level of a local or national government.A substance (player) added to a mixture (scoper) to prevent microorganisms (fungi, bacteria) to spoil the mixture.The source is a direct quote from the target.relationship between act and participationA trigger-match links an actual service (e.g., an observation or procedure that took place) with a service in criterion mood. For example if the trigger is "observation of pain" and pain is actually observed, and if that pain-observation caused the trigger to fire, that pain-observation can be linked with the trigger.A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type.An act that contains summary values for a list or set of subordinate acts. For example, a summary of transactions for a particular accounting period.A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service.
The financial transaction will define the charge (bill) for delivery or performance of the service.
Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.An integer specifying the position of the Entity playing the Role with respect to the Entity that scopes the Role.
This attribute is primarily used with respect to containment roles. For example, some containers have discrete positions in which content may be located. Depending on the geometry of the container, the position may be referenced as a scalar ordinal number, or as a vector of ordinal numbers (coordinates.) Coordinates always begin counting at 1.
Some containers may have customary ways of referring to the positions or no way at all. In absence of any specific regulation for a specific container type, the rule of thumb is that the coordinate that is changed earlier is positioned first. For an automated blood chemistry analyzer with a square shaped tray, this means that the first coordinate is the one in which direction the tray moves at each step and the second coordinate is the one in which the tray moves only every 10 (or so) steps.A code specifying the state of Entity.The source act is a single occurrence of a repeatable target act. The source and target act can be in any mood on the "completion track" but the source act must be as far as or further along the track than the target act (i.e., the occurrence of an intent can be an event but not vice versa).The language used in documenting the Act.A relationship in which the source act is covered by or is under the authority of a target act. A financial instrument such as an Invoice Element is covered by one or more specific instances of an Insurance Policy.A credit relationship ties a financial transaction (target) to an account (source). A credit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account credit will decrease the account balance. A non-asset account credit will decrease the account balance.A time expression specifying the focal or operative time of the Act, the primary time for which the Act holds, the time of interest from the perspective of the Act's intention.
Examples: For clinical Observations, the effectiveTime is the time at which the observation holds (is effective) for the patient.A telecommunication address for the Entity.A code specifying the threat or hazard associated with the Entity.A character string containing a formal language expression that specifies how the Act's attributes are (should be or have been) derived from input parameters associated with derivation relationships.A word or phrase by which a specific Act may be known among people.
Example: name of a research study (e.g. "Scandinavian Simvastatin Study"), name of a court case (e.g. "Brown v. Board of Education"), name of another kind of work project or operation. For acts representing documents, this is the title of the document.An indicator specifying that the Act statement is a negation of the Act as described by the descriptive attributes.The target act is a desired outcome of the source act. Source is any act (typically an intervention). Target must be an observation in criterion mood.A relationship between a source Act that seeks to reverse or undo the action of the prior target Act.A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently.A unique identifier for the Role. One role can be a set of identifiersA code specifying limits regarding the disclosure of information about Act.
It is important to note that good confidentiality of the medical record cannot be achieved solely through confidentiality codes to mask individual record items from certain types of users.
Aggregations of data should assume the privacy level of the most private action in the aggregation.A code distinguishing whether an Act is conceived of as a factual statement or in some other manner as a command, possibility, goal, etc.An action taken with respect to a subject Entity by a regulatory or authoritative body with supervisory capacity over that entity. The action is taken in response to behavior by the subject Entity that body finds to be undesirable.
Suspension, license restrictions, monetary fine, letter of reprimand, mandated training, mandated supervision, etc.
Note: the definition and examples for this concept seem more of a action than that of a relationship between two roles. See "note"A name for the Entity instance.A code specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably represented as an ActRelationship of type "has reason" linking to another Act.A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention). Target must be an observation in criterion mood.An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation.A textual or multimedia depiction of a certificate issued by the scoping Entity of a Role certifying that this Role is indeed played by the player Entity.Relates either an appointment request or an appointment to the order for the service being scheduled.Code specifying the level within a hierarchical Act composition structure and the kind of contextual information attached to composite Acts ("containers") and propagated to component Acts within those containers. The levelCode signifies the position within such a containment hierarchy and the applicable constraints.A contraindication is just a negation of a reason, i.e. it gives a condition under which the action is not to be done. Both, source and target can be any kind of service; target service is in criterion mood. How the strength of a contraindication is expressed (e.g., relative, absolute) is left as an open issue. The priorityNumber attribute could be used.An act relationship indicating that the source act follows the target act. The source act should in principle represent the same kind of act as the target. Source and target need not have the same mood code (mood will often differ). The target of a sequel is called antecedent. Examples for sequel relationships are: revision, transformation, derivation from a prototype (as a specialization is a derivation of a generalization), followup, realization, instantiation.Expresses values for describing the relationship between a FinancialTransaction and an Account.Specifies the quantity of the given entity, as interpreted in coordination with the determiner_cd. For individual instances of Entities, the qty is 1. For a group of individual members, the qty is the number of individual members in the group.
When the Entity instance is a portion of a substance, the qty specifies the amount of that substance comprised by that portion. For an undetermined substance (kind) the qty servers two purposes at the same time: (a) it provides a means of relations between quantities specific for that substance, and (b) it is a reference quantity for the specification of ingredients or components.
In all cases, the qty is an extensive "amount" kind of quantity (e.g., number, length, volume, mass, surface are, energy, etc.) Note that most relative or fractional quantities are not amounts, in particular, mass fraction, substance concentration, mass ratios, percentages, etc. are not extensive quantities and are prohibited values for this attribute.
With undetermined kinds, the qty is but a reference quantity for the specification of the proportion of ingredients or components (e.g. through a has-part, has-ingredient, or has-content Role.) For example, a kind of group with 60% females is Person(qty = 100) has-part Person(qty = 60; sex = female). Amoxicillin 500 mg per tablet is Material(Tablet, qty = 1) has-ingredient Material(Amoxicillin, qty = 500 mg). Glucose 50% (D5W) is Material(D5W, qty = 1 kg) has-ingredient Material(Glucose, qty = 50 g).
Material-specific quantity relations are expressed using the fact that the data type of this attribute is a set of physical quantity (SET<PQ>). If more than one qty value are specified in this set, each element in this set is considered to specify the same amount of the material. For example, for one liter of water one could use the set 1 L, 1 kg, 55.56 mol to specify the volume, mass, and amount of substance for the same amount of water, this is equivalent with specifying the mass density (volumic mass 1 kg/L) and the molar mass (18 g/mol). For Glucose one could specify 180 g, 1 mol according to the molar mass (180 g/mol).A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal to observation) can be "calculated" and need not be sent explicitly.A textual or multimedia description (or reference to a description) of the Act.A time expression specifying the point in time at which information about Act first became available.
For HL7 messaging, the Act.availability_time will be set according to the sender system.
The Act.availability_time is an inert attribute with respect to the mood code. This means, it is the recording time of the act object regardless of its mood.
Rationale: A database that records a separate time stamp for both valid time and transaction time is called a bi-temporal database. Bi-temporal databases allow reconstructing at any time what users of the database actually could have known, versus what the state of the world was at that time. For example, one might record that a patient had a right-ventricular myocardial infarction effective three hours ago, but we may only know about this unusual condition a few minutes ago. Thus, any interventions from three hours ago until a few minutes ago may have assumed a usual left-ventricular infarction, which can explain why these interventions may not have been appropriate in light of the more recent knowledge about the prior state. However, the transaction time (or recording time) may vary from system to system.The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action.A new order that adds to, but does not completely replace its predecessor.A noteworthy undesired outcome of a patient's condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed.The target Role is part of the Source Role.A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal to observation) can be "calculated" and need not be sent explicitly.This is the inversion of support. Used to indicate that a given observation is explained by another observation or condition.An interval of integer numbers stating the minimal and maximal number of repetitions of the Act.
The number of repeats is additionally constrained by time. The act will repeat at least the minimal number times and at most, the maximal number of times. Repetitions will also terminate when the time exceeds the maximal Act.effective_time, whichever comes first.A relationship in which the target act authorizes or certifies the source act.A telecommunication address for the entity while in that Role.The source Role has indirect authority over the target role in a chain of authority.A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood.A code specifying the state of Role.An indicator specifying whether Act is interruptible by asynchronous events.The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act entered into the source Act by means of the target Transportation act.The source act documents the target act.A relationship that provides an ability to associate a financial transaction (target) as a cost to a clinical act (source). A clinical act may have an inherit cost associated with the execution or delivery of the service.
The financial transaction will define the cost of delivery or performance of the service.
Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.The source is an excerpt from the target.reverse function of hasParticipation, relationship between Participation and ActThe relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act departed from the source Act by means of the target Transportation act.Associates a derived Act with its input parameters. E.G., an anion-gap observation can be associated as being derived from given sodium-, (potassium-,), chloride-, and bicarbonate-observations. The narrative content (Act.text) of a source act is wholly machine-derived from the collection of target acts.A code specifying whether Entity represents a class of artifacts or a specific instance of an artifact.An assertion that a new observation was assumed to be the cause for another existing observation. The assumption is attributed to the same actor who asserts the observation. This is stronger and more specific than the support link. For example, a growth of Staphylococcus aureus may be considered the cause of an abscess. The source (cause) is typically an observation, but may be any service, while the target must be an observation.A time expression specifying the occasion time or time of happening for the Act.
This is the time when the action happened, is ordered or scheduled to happen, or when it can possibly happen (depending on the mood of the Act).
When used with procedures and other events, this is the total time of activity including preparation and clean-up actions. Thus it may be longer than the effective time of the same act, which is the period during which the procedure actually takes place.An indicator specifying that the Role is a competency that is not attributed to the Entity playing the Role.
For example, when the Role involves containment, this attribute allows for explicit exclusions. Normally all roles are considered to be affirmative. (This attribute defaults to FALSE.)This is a very unspecific relationship from one item of clinical information to another. It does not judge about the role the pertinent information plays.A relationship that limits or restricts the source act by the elements of the target act. For example, an authorization may be limited by a financial amount (up to $500). Target Act must be in EVN.CRIT mood.iteam locatedA relationship from an Act to a Control Variable. For example, if a Device makes an Observation, this relates the Observation to its Control Variables documenting the device's settings that influenced the observation.A textual or multimedia depiction of the Entity.
The content of the description is not considered part of the functional information communicated between systems. Descriptions are meant to be shown to interested human individuals. All information relevant for automated functions must be communicated using the proper attributes and associated objects.The source Act starts after the start of the target Act (i.e. if we say "ActOne SAS ActTwo", it means that ActOne starts after the start of ActTwo, therefore ActOne is the source and ActTwo is the target).An association between a pair of Acts. This includes Act to Act associations such as collector/component, predecessor/successor, and cause/outcome.
The class has two associations to the Act class, one named "source" the other named "target". Consider every Act_relationship instance an arrow with a point (headed to the target) and a butt (coming from the source.) For each relationship type, the functions (or roles) of source and target Act are different. In principle the assignment of functions (roles) to each side of the relationship "arrow" is completely arbitrary. Since the relationships associated with an Act are considered properties of the source act object. That means that the originator of the information reported in an act object is not only responsible for the attribute values of that object, but also for all its outgoing relationships.
The rule of attribution is that all act relationships are attributed to the responsible actor of the Act at the source of the Act_relationship (the "source act".)
With this recursive act relationship one can group actions into "batteries," e.g., LYTES, CHEM12, or CBC, where multiple routine laboratory tests are ordered as a group. Some groupings, such as CHEM12, appear more arbitrary; others, such as blood pressure, seem to naturally consist of systolic and diastolic pressure.
Acts may also be grouped longitudinally, in a sequence of sub-actions to form temporal and conditional (non-temporal) action paths (e.g., care plan, critical path, clinical trials, drug treatment protocols).
Acts may be explicitly timed, and may be conditioned on the status or outcome of previous actions. Concurrent collections of acts allow expressing logical branches as well as parallel tasks (tasks carried out at the same time.) These constructs can be organized in multiple layers of nesting, to fully support workflow management.
The Act_relationship class is not only used to construct action plans but also to represent clinical reasoning or judgments about action relationships. Prior actions can be linked as the reasons for more recent actions. Supporting evidence can be linked with current clinical hypotheses. Problem lists and other networks of related judgments about clinical events are represented by the Act_relationship link.
The Act_relationship.type_cd identifies the meaning and purpose of every Act_relationship instance.A relationship between a source Act that provides more detailed properties to the target Act.
The source act thus is a specialization of the target act, but instead of mentioning all the inherited properties it only mentions new property bindings or refinements.Used when the target Act is a transformation of the source Act. (For instance, used to show that a CDA document is a transformation of a DICOM SR document.)Specifies under what circumstances (target Act) the source-Act may, must, must not or has occurredA unique identifier for the Act.
HL7: the range is SET<II>Expresses an association that links two instances of the same act over time, indicating that the instance are part of the same episode, e.g. linking two condition nodes for episode of illness; linking two encounters for episode of encounter.A relationship in which the target act is a predecessor instance to the source act. Generally each of these instances is similar, but no identical. In healthcare coverage it is used to link a claim item to a previous claim item that might have claimed for the same set of services.reverse property of playedRoleIn, relationship between role and participationExpresses values for describing the relationship relationship between an InvoiceElement or InvoiceElementGroup and a billable act.A specialization of "has support" (SPRT), used to relate a secondary observation to a Region of Interest on a multidimensional observation, if the ROI specifies the true boundaries of the secondary observation as opposed to only marking the approximate area. For example, if the start and end of an ST elevation episode is visible in an EKG, this relation would indicate the ROI bounds the "ST elevation" observation -- the ROI defines the true beginning and ending of the episode. Conversely, if a ROI simply contains ST elevation, but it does not define the bounds (start and end) of the episode, the more general "has support" relation is used. Likewise, if a ROI on an image defines the true bounds of a "1st degree burn", the relation "has bounded support" is used; but if the ROI only points to the approximate area of the burn, the general "has support" relation is used.A non-unique textual identifier or moniker for the playing Entity intended for use principally when playing the Role.Used to assign a "name" to a condition thread. Source is a condition node, target can be any service.generic part-whole relationship, the subject and object should be the same typeA debit relationship ties a financial transaction (target) to an account (source). A debit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account debit will increase the account balance. A non-asset account debit will decrease the account balance.A connection between two roles expressing a dependency between those roles.
For example: A role of assignment or agency depends on another role of employment, such that when the employment role is terminated, the assignments would be terminated as well. This is the dependency of the assignment role with the employment role, or in other words, the assignment is "part of" the employment. Another use case is to reflect authority of one role over another (in organizational relationships.) For example, an employee of type "manager" may have authority over employees of type "analyst" which would be indicated by a role link for "direct authority".
Role_link specifies the relationships between roles, not between people (or other entities.) People (or other Entities) are primarily related by their direct player/scoper relationships around the player's Role and more generally through their interactions (i.e. their participations in acts)A code specifying a further classification of Role, qualified by the value of the class_cdAssociates a specific time (and associated resources) with a scheduling request or other intent.Reference ranges are essentially descriptors of a class of result values assumed to be "normal", "abnormal", or "critical." Those can vary by sex, age, or any other criterion. Source and target are observations, the target is in criterion mood. This link type can act as a trigger in case of alarms being triggered by critical results.A code or set of codes specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen.
This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities.relationship between role and entityAn addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered.Relates an Act to its subject Act that the first Act is primarily concerned with.This attribute is used for Roles that represent composition relationships between the scoping and playing Entities. It is a ratio specifying the relative quantities of the Entity playing the Role and the Entity scoping the Role.
In composition-relationships (e.g., has-parts, has-ingredient, has-content) it specifies that a numerator amount of the target entity is comprised by a denominator amount of the source entity of such composition-relationship. For example, if a box (source) has-content 10 eggs (target), the relationship quantity is 10:1; if 0.6 mL contain 75 mg of FeSO4 the ingredient relationship qty is 75 mg : 0.6 mL. Both numerator and denominator must be amount quantities (refer to the Entity.qty definition).A goal that one defines given a patient's health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood.An interval of time specifying the period during which the artifact represented by Entity has, had, or will have physical existence.A requirement to be true before a service is performed. The target can be any service in criterion mood. For multiple pre-conditions a conjunction attribute (AND, OR, XOR) is applicable.Indicates that the target Act provides evidence in support of the action represented by the source Act. The target is not a 'reason' for the source act, but rather gives supporting information on why the source act is an appropriate course of action. Possible targets might be clinical trial results, journal articles, similar successful therapies, etc.Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element.The source Role has direct authority over the target role in a chain of authority.A code specifying which particular kind of Act that the Act represents within its class.
The kind of Act (e.g. physical examination, serum potassium, patient encounter, financial transaction, etc.)is specified with a code from one of several, typically external, coding systems. The coding system will depend on the class of Act, such as LOINC for observations, perhaps SNOMED for procedures, etc.relationship between role and participationAn observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-condition".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attributeA code indicating whether the Act statement as a whole, with its subordinate components has been asserted to be uncertain in any way.Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post.)Used to capture the link between a potential service ("master" or plan) and an actual service, where the actual service instantiates the potential service. The instantiation may override the master's defaults.A code specifying special handling requirements for the artifact represented by Entity.
A code to describe how the Entity needs to be handled to avoid damage to it or other entities. Examples include: Keep at room temperature; Keep frozen below 0 C; Keep in a dry environment; Keep upright, do not turn upside down.A code specifying the state of the Act.A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee.A code specifying the class or category of Entities that the specific Entity represents. The code indicates which class in the Entity hierarchy is represented by any instance of Entity.This relationship indicates the source Role is available to the target Role as a backup. An entity in a backup role will be available as a substitute or replacement in the event that the entity assigned the role is unavailable. In medical roles where it is critical that the function be performed and there is a possibility that the individual assigned may be ill or otherwise indisposed, another individual is assigned to cover for the individual originally assigned the role. A backup may be required to be identified, but unless the backup is actually used, he/she would not assume the assigned entity role.The source act fulfills (in whole or in part) the target act. Source act must be in a mood equal or more actual than the target act.source authorizes the target actThis relationship indicates that the source Role replaces (or subsumes) the target Role. Allows for new identifiers and/or new effective time for a registry entry or a certification, etc.A code specifying the class or category of Acts that the specific Act represents. The code indicates which class in the Act hierarchy is represented by any instance of Act.A code specifying which particular kind of Entity the Entity represents within its class
The values for this attribute are drawn from one of several coding systems depending on the class of entities, such as living subjects (typed by animal and plant taxonomies), chemical substance (e.g., IUPAC code), organizations, insurance company, government agency, hospital, park, lake, syringe, etc. Note that Entity.cd may be so fine grained that some types may only have one known instance. Types with an extension of one instance are very similar to names. An example is the CDC vaccine manufacturer code, which is modeled as a concept vocabulary, when in fact each concept refers to only one instance.A code specifying the class or category of Roles that the specific Role represents. The code indicates which class in the Role hierarchy is represented by any instance of Role.he Act has been terminated prior to the originally intended completion.abortedThe state representing the fact that the Entity is currently active in the Role.activesuspendedThe Act has been abandoned before activation.cancellednullifiednullifiedactivecancelledobsoleteThis Act instance has been replaced by a new instance.suspendedActive service object is temporarily suspended.The state that represents a suspension of the Entity playing the Role. This state is arrived at from the "active" state.An Act that is still in the preparatory stages has been put aside. No action can occur until the Act is released.heldThis Act instance was created in error and has been 'removed' and is treated as though it never existed. A record is retained for audit purposes only.terminatedpendingThe state representing the fact that the Entity record is currently active.The state representing the fact that an entity can no longer be an active participant in events.terminatedThe state representing the termination of an Entity record instance that was created in error.nullifiedThe state representing the termination of a Role instance that was created in error.The Act can be performed or is being performed.activeAn Act that has been activated (actions could or have been performed against it), but has been temporarily disabled. No further action should be taken against it until it is released.newThe state representing that fact that the role has not yet become active.The terminal state resulting from cancellation of the role prior to activation.completedAn Act that has terminated normally after all of its constituents have been performed.